GI disorders: Don’t ignore the symptoms

Gastrointestinal disorders are among the most common medical conditions, yet some people hesitate to discuss them with a doctor—especially those that affect bathroom habits.

But GI conditions aren’t limited to the bowel. They comprise a variety of issues, from heartburn to hepatitis C. And these disorders can range in severity from mildly annoying to debilitating and potentially life-threatening. In other words, they’re well worth talking about.

People with GI symptoms who are reluctant to speak to a doctor should remember that most people experience GI issues at some point in their lives and it’s not necessary to suffer in silence. There are effective treatments, and with the help of your doctor it’s possible to eliminate or effectively manage the symptoms caused by most common GI disorders.

Chronic heartburn

One of the most widespread GI disorders is gastrointestinal reflux disease (GERD), more simply known as chronic heartburn. “Probably more than half of adults in America have symptoms of GERD,” says Steven Weinstock, M.D., a gastroenterologist at Providence Little Company of Mary Medical Center Torrance. “We don’t get too worried unless it occurs more than two or three times a week. But if you’re having weekly symptoms, you should at least call your doctor.”

The problem itself is simple to understand—acid from the stomach moves through the sphincter at the bottom of the esophagus and into the esophagus. The specific causes can be harder to pin down, however, in general, it’s believed to be a weakness in the lower esophageal sphincter muscle.

The symptoms of GERD can go beyond frequent heartburn to include other problems such as:

Obesity and poor diet also can exacerbate GERD. “Obesity increases intra-abdominal pressure, especially when laying down— forcing the sphincter muscles to open. Alcohol, caffeine and medications for other illnesses can also relax the sphincter,” says Rudolph Bedford, M.D., a gastroenterologist at Providence Saint John’s Health Center in Santa Monica, Calif.

Treatments for GERD

There are a number of treatments for GERD, though there are no surefire cures. The best medications work by neutralizing the acid rather than tightening the lower esophageal sphincter muscle. The most effective of these are proton-pump inhibitors, which suppress the production of stomach acid. H2 blockers are less potent but also effective and may be safer.

Laparoscopic Nissen fundoplication, a surgical tightening of the sphincter, is an effective treatment for some patients. “Generally, most patients can manage it pretty well with medication,” Dr. Weinstock says. “What’s worrisome is it can be a risk factor for esophageal cancer.”

That’s why doctors’ biggest concern for patients with GERD is letting it go unchecked. Left untreated GERD can cause cellular damage to the inside of the esophagus, a condition called Barrett’s esophagus. With this, the esophagus is constantly bathed in stomach acid, which can replace the lining with tissue similar to the intestinal lining.

Barrett’s esophagus is associated with an increased risk of developing cancer. However, only 1 percent of GERD sufferers have Barrett’s esophagus, Dr. Weinstock says.

Irritable bowel syndrome

Another common GI disorder among Americans is irritable bowel syndrome (IBS). “At least 10 percent of the population has IBS,” Dr. Bedford says. “It’s a complex and not very well understood condition. There’s no known organic cause, but it could come from a variety of stressors—anything from psychological to food-related or hormonal issues. Some patients even get it after an infection or post-traumatic stress.”

The symptoms of IBS are ones everybody experiences at some point—cramping, abdominal pain, bloating, gas and either diarrhea or constipation. “Everybody has cramping,” Dr. Weinstock says. “But once it goes for three to four months, with three to four days a month of symptoms, it’s best to see a doctor.”

As with GERD, the treatments for IBS tend to focus on relieving the symptoms and managing the condition rather than providing a cure. Over-the-counter medications like Imodium, fiber supplements and stool softeners can help, though it’s still a good idea to consult with a doctor to ensure IBS is the correct diagnosis rather than a disease like Crohn’s or ulcerative colitis. In patients older than 50, colon cancer must be ruled out.

Don’t wait – get checked

Another benefit to seeing a doctor is the opportunity to get tested for small intestinal bacterial overgrowth, or SIBO. This is a condition in which large populations of bacteria from the colon grow in the small intestine, and it can be the cause of IBS in some patients.

Fortunately, it’s easy to test for and treat. “We use a hydrogen breath test that looks for SIBO and then treat it with a two-week course of non-absorbable antibiotics called rifaximin,” Dr. Bedford says.

Also like GERD, leaving IBS untreated— or assuming a condition is IBS without consulting a doctor—can potentially lead to much larger problems.

“Untreated, people can feel miserable,” says Robert Moghimi, M.D., gastroenterologist at Providence Holy Cross Medical Center in Mission Hills, Calif. “And if it’s actually an inflammation, rather than IBS, it could spread throughout the colon or into the small intestine.”

Signs of a more serious condition include:

Bleeding

Weight loss

Experiencing symptoms at night

Regardless of whether someone has IBS or not, getting regular screenings for colon cancer is one of the best things anyone can do—not only for their gastrointestinal health but for their health overall.

“Colon cancer is the one cancer we can prevent from ever occurring if people just get a colonoscopy when they’re supposed to,” Dr. Bedford says. “It’s an urban myth that it’s painful or embarrassing, and the risks are exceedingly low. But about one-third of people will have a polyp, and those may or may not be precancerous. There’s just no way to predict without doing the test.”

If you think you might have a GI disorder, or you have been diagnosed with a GI disorder and have questions about treatments, contact your primary care physician or ask to be referred to a gastroenterologist in your area.

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